While I have explored many areas that will be impacted by Brexit I have yet to delve into the effects it will have on the National Health Service. I know the headlines and some basic facts which have been spread around but, like many, I have not taken the time to really look behind the propaganda and basic headlines. In this article, I have decided to change that. Here I try and investigate some of the key areas as I see them; staffing, medical supplies, budgets and research.
Staffing
Our NHS is staffed by some of the most dedicated people in the world. They work long hours for low pay and are there to help us all when we need it most. They are often abused by drunkards and ungrateful souls with too much hatred in their hearts, but still, they provide the care that is required no matter the patient or the ailment.
I was aware that a large proportion of NHS staff came from overseas and given the nature of Brexit this is bound to have an effect. But just how big will that effect be? According to researchers at the University of Birmingham, about 130,000 NHS staff come from other countries[1]. The House of Commons library puts that figure even higher at 153,000[2]. Not all of these are from the EU however I expect the vast majority are.
The EU has agreements in place which recognise common qualifications allowing EU national trained with the EU to work in the medical profession here in the UK. That means the UK did not have to pay for the training of all the staff it now employs. For example, around 28% of doctors and 13% of nurses working in the NHS have trained abroad, not all in the EU[3]. The level of foreign-trained medical professionals is far higher in the UK than is it in other EU countries. This means that the UK is benefiting hugely by not having had to pay for training these professionals. It also makes the NHS an amazingly diverse employer. But already this has been impacted by Brexit with a fall of over 30% in non-UK born staff working in the NHS since the referendum. That is a really disheartening loss.
Recent announcements from Priti Patel now suggest that immigrants will have to earn more than £36,000 a year before tax. That is significantly more than the average nurse earns or junior doctor earns. So, does that mean the end of foreign nurses and doctors? And before the racists and bigots jump in shouting for joy, remember the UK doesn’t train enough medical staff to replace those it will lose. It is clear that the NHS workforce will be significantly diminished as a result of Brexit. While those EU residents that are currently working in the NHS can apply for Settled Status, not all will want to, possibly not feeling welcome anymore in a country they have contributed to in many ways. I can say right now, you are welcome, and I thank you for all you have done for the UK and the NHS and hope you all choose to stay.
It is also true to say that the vast majority of staff in the NHS are British born citizens. However, with over 100,000 vacancies in the NHS, the UK cannot train that number of replacements so it can ill afford to lose potentially thousands more skilled personnel.
Supplies
At the end of 2018, the government's standpoint was that the chances of a No Deal Brexit were very low and as such there was no need for any stockpiling of medical supplies or anything else for that matter. Since then, however, we have had a new, undemocratic and unelected, government take control. The new policy seems to be roughly: make ridiculous demands of the EU that they can never agree to and then to blame them for the inevitable No Deal (otherwise rightly known as a crash out) Brexit. This is of course what Boris Johnson has been planning for all along, however, I am not going to go into that in this blog. You can read the previous entry if you want to dive down that rabbit hole http://www.theworldneedssaved.com/2019/07/boris-clown-made-prime-minister.html.
So, now we face the more likely scenario of a crash-out Brexit. But never fear with less than three months to go the government has started stockpiling some crucial, but not all, medicines. But how can it possibly get all the NHS will need in time. Even orders placed now will require time to manufacture and deliver in amongst all the normal orders. Some of these medicines are already in short supply. According to the British Menopause Society[4], many HRT (Hormone Replacement Therapy) drugs are in short supply. Additionally, it was reported recently that IV feed drips are in short supply[5], while this is not Brexit related, the NHS is now trying to import required supplies from abroad? But how easy will this be once we have left the agreement with our closest neighbour and largest trading partner? Even if we turn to local suppliers in the UK, they need supplies to manufacture their goods. Some of these are imported as well. Therefore, they may face difficulties meeting demands as well.
Can we actually stockpile enough medical supplies between now and the 31st of October? How much is enough? How long will the potentially miles long queues at ports around the country last? Some have naively claimed there will be no queues while others have pointed out that even an additional two minutes of checks per lorry load coming in or going will ensure there are tailbacks for months. How will the NHS get the supplies it needs?
NHS Budgets
Brexit is already negatively influencing NHS finances. With the pound at a low level against both the Dollar and the Euro, the cost of importing drugs and other medical supplies is increasing significantly, as are all imports. This means the NHS will be able to buy fewer medical supplies from abroad and could exacerbate any shortages due to long import delivery times after/if Brexit happens. But it is not just imported goods that are going to go up in price. As I said above local suppliers must import some components as well. If their costs go up, then naturally the cost of the goods they supply must also increase as well.
I must also mention the Brexit bus. Yes, it has been raised numerous times before but, it is still very relevant. £350 Million per week was promised by Boris Johnson and his Leaver mates. Soon after winning the referendum that claim was quickly retracted. Now Boris is claiming that he is “gifting” an additional £1.8 Billion of “new money” to the NHS, but that as it turns out is mostly made up of money already assigned to the NHS but which they were not allowed to spend.
Now, if after Brexit the economy takes the expected hit and GDP retracts by around 9%, Bloomberg have reported it could be higher[6], then that will mean there is less money coming into the treasury which will likely mean a hit on various departments budgets, including I would guess the NHS as austerity kicks in again, hard. This would mean a combination of increasing costs and potentially lower budgets. The NHS already has a massive shortfall in funds how is it meant to cope with yet another hit like the one Brexit will bring?
The Health Foundation reported in 2016[7] that the projected NHS budget shortfall by 2030/31 could be as much as £19 Billon or £365 Million a week. That was if it stayed in the EEA (European Economic Area). However, that’s not likely to happen and it’s not even being discussed as an option anymore. In that case, they predicted that the shortfall could be £28 Billion or £540 Million a week. It’s hard to see this as anything other than problem growing rapid out of control that could easily bankrupt the NHS.
Another area where the NHS faces risk is in the Governments pursuit of a trade deal with the United States of America. Any trade deal is likely to rely on access to the buying or selling services and goods with the NHS. Have you seen the prices Americans have to pay for certain drugs? Insulin costs so much that Americans nearer Canada make regular trips over the border just so they can afford to pay for the stuff they need to stay alive. Do we really want to expose the NHS to those types of costs and rampant, excessive capitalism?
Research
It is true to say that the NHS has benefited from a pan-European collaboration when it comes to medical research. Access to facilities, researchers, clinical trials and funding from EU programmes has advanced the front of medical knowledge considerably and saved many lives in the process. While it would be wrong to say that all this will stop if Brexit occurs it is true to say it will be significantly impacted. With no agreements in place, especially in a No Deal scenario, there will be no EU funding, limited or no access to EU facilities and clinical trials and researchers will face new, although not insurmountable, obstacles trying to travel to and from the UK especially to work. Research depends on free and easy collaboration, Brexit flies in the face of this philosophy by putting barriers in its way.
Boris Johnson has announced measures to ensure scientists from all over the world can come to the UK. While great in principle it does not replicate the freedom of movement we have now with the EU. In addition, what are the incentives for scientists to come here? It is the low value of the pound, which is what they would probably be paid in, maybe it’s the obstacle of having to earn £36,000 a year before they are allowed to stay. What about the hostile environment that Leavers have created by following the rhetoric of people like Nigel Farage and Johnson? While we will still have world-class facilities how will we attract the researchers to work in them? Hard to answer in such a climate.
Since 2010 the European Research Council (ERC) has helped to fund over 1,800 research projects in the UK alone[8]. The following graph shows the number of grants awarded per ERC member since 2010 and limited to the top 15.
As this clearly shows, the UK has been the biggest beneficiary of this grant system. Will the government match these funding pledges? Even if it does initially can it maintain it in the face of the economic problems Brexit will cause? Or will funding for research fall away in favour of tax cuts for big business and top-rate income tax cuts.
Conclusion
It is painfully obvious that Brexit holds many challenges for the NHS. No sorry, that seems too weak. Brexit could actually end the NHS. With another potential round of austerity and increasing costs combined with a probable fall in research funding, it is easy to see that at the very least the NHS will struggle to maintain its current world-class service and leadership in various research areas.
Let’s not beat around the bush here the NHS exists to save lives. If it loses access to collaborative research and clinical trials lives will be lost that could have been saved. In additional if its medical supplies run low enough it could mean operations being postponed and again the potential for lost lives.
But never mind if Britain Trump gets his way the whole bloody lot will be sold to the USA for a nice tidy profit for…well probably the government which will use it to pay for even more tax cuts for the rich and big business. Maybe it will even go towards a nice personal army dedicated to Johnson’s protection from the masses dying of flu, cancer of diabetes as that they can’t afford to go to hospital to get the treatments they need.
Can we cancel Brexit yet, please?
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